Peritoneal dialysis treatment of metformin-associated lactic acidosis in a diabetic nephropathy patient

We report a case of metformin- associated lactic acidosis (MALA) in a 66-year-old man with end-stage renal disease on peritoneal dialysis (PD). The patient presented with severe lactic acidosis and was treated successfully with automated peritoneal dialysis (APD). During the treatment, PD solution was prepared from hemofiltration substitute fluid. The prescription was 8 cycles of 2,000 mL over 24 hours with the prepared solution, and venoclysis with sodium bicarbonate to improve the acidosis. After 3 days of treatment, his lactic acidosis was corrected. This case demonstrated that PD using hemofiltration substitute fluid is an option for patients with MALA.